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General NPI Number Information
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NPI Number | 1881771293
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Entity Type | Individual
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Provider Name | PEGGY M BLENKUSH P.T.
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 25945 GATEWAY DR
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City | ZIMMERMAN
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State | MN
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Zip | 55398-5300
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Country | US
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Telephone | 763-856-6930
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Fax | 763-856-6933
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Provider Business Mailing Address
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Address Line | 13133 170TH AVE SE
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City | BECKER
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State | MN
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Zip | 55308-8503
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Country | US
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Telephone | 763-856-6420
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Fax | 763-856-6933
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4171
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License Number State | MN
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